Commentary: Winning the battle for local control without losing war for survival against malignant pleural mesothelioma

Our plain-English summary of Commentary: Winning the battle for local control without losing war for survival against malignant pleural mesothelioma, by A. Bribriesco (The Journal of Thoracic and Cardiovascular Surgery, 2021).

The study

• Author: A. Bribriesco
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2021;161(4):1520-1522
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This article is a short commentary by a thoracic surgeon at the Cleveland Clinic, not an original study. It discusses a separate study by Hod and colleagues at Brigham and Women's Hospital of 501 patients with malignant pleural mesothelioma who had cytoreductive surgery. In that study, 82% also received heated cisplatin chemotherapy inside the chest during the operation. As the commentary describes it, acute kidney injury occurred in 48.3% of patients overall and was more common with the heated chemotherapy (53.5% vs 24.2%). Kidney injury was also more common after extrapleural pneumonectomy than after pleurectomy/decortication. Stage III kidney injury was associated with longer hospital stays and increased risk of death. The observed survival benefit of surgery plus heated chemotherapy was limited to patients without kidney injury. The author noted that this study was not designed to assess cancer outcomes. Citing other surgical series, the author argued that better local tumor control may not mean longer survival. The author concluded that tumor destruction must be balanced against the physiologic cost to the patient. The commentary does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Commentary (editorial opinion) on another study published in the same journal; no original data
• Who was studied: No population of its own. The commented study (Hod and colleagues, Brigham and Women's Hospital) included 501 patients with malignant pleural mesothelioma who had cytoreductive surgery; 48% had extrapleural pneumonectomy.
• Exposure: Not asbestos. The treatment discussed was cytoreductive surgery (extrapleural pneumonectomy or pleurectomy/decortication), with or without cisplatin-based hyperthermic intraoperative chemotherapy.
• Main results:
  • As reported in the commentary about the Hod study: acute kidney injury occurred in 48.3% of all patients, and more often in those given heated intraoperative chemotherapy (53.5%) than in those not given it (24.2%).
  • As reported in the commentary about the Hod study: kidney injury was more common after extrapleural pneumonectomy than after pleurectomy/decortication, and stage III kidney injury was associated with increased length of stay and risk of death.
  • As reported in the commentary about the Hod study: the observed survival benefit of surgery plus heated chemotherapy was limited to patients who did not develop kidney injury. The study was not designed to assess cancer-specific outcomes.
  • The author argued, citing other published series, that the view that local disease control equals improved survival is being challenged.
• The authors' conclusion: The author concluded that curative mesothelioma treatment includes aggressive local control, but that pursuing microscopic tumor destruction must be balanced against the physiologic cost to the patient.
• Limitations the authors state:
  • The author noted that the commented study was not designed to assess cancer outcomes and gave no data on disease-free or overall survival.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Commentary: Acute kidney injury after intrapleural cisplatin: Minimizing collateral damage — M.I. Ebright (2021)
• Commentary: Cisplatin-induced nephrotoxicity following cytoreductive surgery and heated intraoperative chemotherapy for malignant pleural mesothelioma — S.S. Groth, R.T. Ripley (2021)
• Commentary: Know your enemy-Understanding futility in the battle against malignant pleural mesothelioma — A.E. Giles, B. Kidane (2020)
• Acute kidney injury after cytoreductive surgery and hyperthermic intraoperative cisplatin chemotherapy for malignant pleural mesothelioma — T. Hod, K.J. Freedberg, et al. (2021)
• Commentary: Local chemotherapy with nanoparticles: A ray of light in the dark? — S. Nakamura, T.F. Chen-Yoshikawa (2020)
• Detection of Drug-Induced Acute Kidney Injury in Humans Using Urinary KIM-1, miR-21, -200c, and -423 — M. Pavkovic, C. Robinson-Cohen, et al. (2016)

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